August 9, 2021, 2:36 p.m. David Mitchell — It didn’t take long for Tina Tanner, M.D., to get her faculty’s attention during her intern year at the family medicine residency in Saginaw, Mich. Tanner sent more patients to counseling than other residents, filed more reports with Child Protective Services, and her patients with obesity were losing weight.
Patients’ lives were changing for the better, and faculty member Stuart Rupke, M.D., wanted to know the resident’s secret.
“He said, ‘What are you doing? What’s your motivational interviewing style? How are you accomplishing this with people?’” said Tanner, who suggested to Rupke that she was merely lucky.
It took two years for Tanner to confide to Rupke that she actually knew how to talk to people who had been abused because she had experienced it herself as a child.
“Growing up in that environment, you see things and you see signs that other people might not recognize,” she said, “so you ask questions differently because you also were trained what to say and what not to say in certain situations. When people give me a certain line, I think, ‘Yeah, that’s interesting. There’s more to this, but you’re not ready to tell me what the more is yet.’”
Rupke encouraged Tanner to develop a presentation that would help other physicians recognize those signs and understand how to talk people through difficult situations. She wasn’t ready. Rupke understood but walked away with a promise that Tanner would someday teach what she knew.
Years later, Tanner took a job at a federally qualified health center in Muskegon, a “phenomenal experience” that brought her closer to sharing her story with her peers.
“There were just so many people that really needed an advocate, and that FQHC was so supportive,” she said. “We had so many community programs, and we could develop them and do what we wanted with them. That’s when I started looking more at trauma-informed care because the kids living in the projects behind our health center had lives that most people couldn’t even fathom.”
Tanner could. She knew exactly what it was like to be poor and abused. She recalled being told to line up for lunch on the first day of first grade and not understanding where her class was going. She didn’t know what “lunch” meant because she’d never had it before.
School and books offered an escape from a rough life at home. When she found out in fifth grade that her favorite uncle had cancer, she checked out 20 books on that subject from the local library. A year later, Tanner was assigned a three-page research paper. She turned in her 40-page report on cancer two days late but still got an A.
“My outline was three pages,” she said.
A year later, her beloved uncle died. Around that same time she informed her father, bluntly, that she’d had enough of his beatings.
“I don’t know what came over me to this day, but I looked at him and I said, ‘I know you’re going to hit me, so if you’re going to hit me go ahead and get it over with,’” she said. “‘But if you do hit me, make sure I stay down.’”
When Tanner’s father asked what she meant by that, she reminded him that he had taught her how to fire a gun and he eventually would have to go to sleep.
“He just looked at me, and I have no idea how long it lasted because I thought for sure I was going to die,” she said. “I was a scrawny, little 13-year-old kid. I probably wasn’t even 5 foot tall. All of the sudden he turned around and walked out the door. He never hit me again.”
Tanner said telling patients just a little bit about her own struggles changes their perspectives.
“They’re so certain that nobody’s experienced the life that they have,” she said, “and that can be a powerful moment to help them out of their situation. You don’t have to share everything, but just saying, ‘I understand. My father wasn’t a nice person,’ will make them look at you, and you can make that connection in a couple minutes if you can hold that gaze. It’s hard work. It makes me reflect on what I went through, so sometimes that’s a little difficult, but it’s one of the most fulfilling things you can do when you can get people through a hard time.”
A few years ago, a mother asked for Tanner’s help because her teenage son’s grades had plummeted and his weight had skyrocketed. Visits with counselors had netted no change, and the boy was becoming increasingly isolated.
In her clinic, Tanner turned her laptop around to the patient and pointed to the spot where his growth curve had drastically diverged from normal and asked him what scary, painful thing had happened that changed his life.
“This 16-year-old kid just started to cry,” Tanner said. “He had been severely abused and bullied by a teacher at his school.”
That teacher was fired. Following two years of counseling and visits, the boy graduated, started college and got a job.
“When you can do those kinds of things for folks, that’s big,” she said. “That’s when you look at your own story and say, ‘OK, I know why I went through what I went through because now I can make a difference in other people’s lives.’”
Tanner, the past president of the Michigan AFP, has also found her voice on the subject of abuse outside the exam room. She kept her promise to Rupke and has given multiple presentations to her chapter and others, and hopes to do more post-pandemic.
“It is one of my passions, but I find advocacy on any level in family medicine is my passion whether it’s for patients, communities or governmental,” said Tanner, a regular attendee of the AAFP’s National Conference of Constituency Leaders. “You can give people voices and advocate in so many different ways in family medicine. That’s why NCCL has been a really important conference for me, because it’s about making sure that everyone’s voice is heard and being there and learning from those different voices is so important.”
Tanner has practiced for more than two decades in her native state. In addition to the FQHC, she has been in private practice, done full-scope practice with obstetrics in a rural setting, been an EHR champion and database manager, and a medical director.
“That’s my attraction to family medicine, being able to explore any area that I want to explore,” she said. “If you’re curious about something in family medicine, you can start digging into it and take it as far as you want. It gives you so many opportunities, you can do so many different things, and I’ve never ever been bored.”